Provider Demographics
NPI:1720501588
Name:MOHAMED, AHMED HATEM
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:HATEM
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0553
Mailing Address - Country:US
Mailing Address - Phone:409-772-1533
Mailing Address - Fax:832-632-7866
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0553
Practice Address - Country:US
Practice Address - Phone:409-772-1533
Practice Address - Fax:832-632-7866
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10072194207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease